The Role of Nutrition in Optimal Wound Healing
Malnutrition, an imbalance between nutritional intakes and requirements, causes measurable adverse effects on the human body. This imbalance is a common risk factor that significantly impairs optimal wound healing. Thus, patients and wound care professionals must prioritize the intake of relevant nutrients to ensure adequate wound management and expedite wound healing.
Nutrition: An Overview in Light of Wound Management
The body requires the proper nutrients to function effectively. Relevant healthcare stakeholders have prioritized the availability and intake of optimal nutrition for the promotion of public health over the past decades.
Nutritional factors address many health issues, such as heart failure and diabetes, and promote patient wellbeing. Similarly, wound patients and caregivers/professionals must account for the impact of proper diet in the healing process.
Studies have shown that patient undernourishment or starvation can lead to delayed wound healing. Hence, wound patients must increase their intake of nutritious diets that promote healing, including amino acids, zinc, vitamin A, vitamin B complex, vitamin C, vitamin E, copper, carbohydrates, and fat, as well as adequate hydration.
Understanding the Wound Healing Process
Understanding the wound healing process gives a clearer understanding of the role nutrition plays in wound healing. The wound healing process comprises four (4) key phases, including the coagulation, inflammatory, proliferation, and remodeling phases.
This initial wound repair phase begins immediately after the wound occurs. Here, the body activates an emergency repair system, ensures blood clotting (hemostasis), and minimizes wound drainage. Hemostasis begins with fibrin plug formation, which protects the wound from infection.
In this second phase, the wound exhibits localized inflammation, redness, swelling, warmth, pain, and loss of function. These responses aid the prevention of infection and kickstart the rest of the healing process.
The body ensures the elimination of bacteria (through increased exudates), the removal of debris, and prepares the wound bed for the growth of new tissues in this phase. Note that this phase can last up to 6 days.
This phase lasts about 4 to 24 days and involves the body forming a protective layer across the wound site. Here, the integration of fibroblasts with collagen knits the tissue together to form a covering.
Moreover, the phase enables the transformation of fibroblasts to myofibroblasts and the replacement of injured tissues with new ones.
This final phase of the wound healing process can last up to two years post-injury. The remodeling phase enables the maturation of collagen, closure of the wound, and the formation of scar.
Moreover, the body improves the tensile strength of the newly-formed tissues by reorganizing their structures in this phase.
Top Nutrients for Wound Healing
Several macronutrients and micronutrients impact the wound healing process and contribute to overall patient recovery.
Macronutrients for Wound Healing
Proteins, amino acids, carbohydrates, and fats provide significant energy that fuels the repair of damaged tissues. Proteins synthesize wound-healing enzymes, aid the proliferation of cells and collagen, and create connective tissues. Moreover, a sufficient supply of protein enables fibroblasts to proliferate and close the wound.
Wound patients experiencing protein deficiency are susceptible to slower healing resulting from impaired collagen synthesis and deposition, increased wound infection rates, and reduced skin and fascial wound-breaking strength.
Arginine and glutamine are two common amino acids essential in wound healing. While the former increases lymphocyte proliferation for increased collagen formation and lower fistula formation rates, the latter serves as a precursor for nucleotides in fibroblasts, aids gluconeogenesis, energizes lymphocytes, and stimulates the inflammatory immune response.
Ultimately, both amino acids significantly contribute to expediting and improving wound healing. Similarly, carbohydrates and fats provide the required energy for collagen synthesis and other wound-healing-associated tasks.
Carbohydrates and fats deficiencies can result in limitations in the production and utilization of fibroblasts, leukocyte activities, hormone stimulation, and growth factor production in patients with wounds.
Micronutrients for Wound Healing
Several micronutrients, including vitamins and minerals, including vitamins A, B, C, and K, magnesium, copper, and zinc, play crucial roles in wound healing.
For instance, vitamin A increases collagen deposition by fibroblasts and inflammatory response for optimum wound healing. Wound patients require an estimated 10,000 to 50,000 IU per day of oral vitamin A supplements in line with Dietary Reference Intakes (DRIs).
Moreover, vitamin A can rectify impaired wound healing due to underlying issues, such as tumor formation, corticosteroid, cyclophosphamide, diabetes, etc. B vitamins, including riboflavin, folic acid, thiamine, pyridoxine, and pantothenate, provide energy for wound healing.
Vitamin C deactivates radicals and oxidants and supports collagen synthesis for improved wound healing. Daily supplementation of 500mg of vitamin C with a combination of 17 mg of Zinc and arginine is helpful for wound healing.
Similarly, vitamin K positively impacts wound healing by aiding effective coagulation, especially in vitamin K-deficient patients. Conversely, Vitamin E adversely affects wound healing by compromising collagen synthesis and antioxidant responses and neutralizing the wound healing effects of vitamin A.
Finally, magnesium, copper, and zinc support wound healing by energizing immune cells, strengthening collagen frameworks, and producing antibodies. Moreover, deficiency of these micronutrients can adversely affect each phase in the wound healing process. Thus, wound patients require proper nutrition supervision to ensure adequate intake of these nutrients.
How to Incorporate Nutrition into Wound Healing
Professionals must consider several factors when incorporating nutrition into wound care, including the following:
- The current deficiencies of the patient: a review of the nutritional deficiency symptoms of the patient is crucial.
- The energy requirements of the patient: adjusting overall caloric intake can account for increases in energy requirements.
- Patient comorbidities and nutrient intake/absorption issues
After accounting for these factors, professionals must formulate a suitable diet and identify an effective delivery method for the recommended nutrients. While enteral nutrition remains a top effective delivery method, supplementation is necessary for patients with additional needs.
The wound healing process comprises coagulation, inflammatory, proliferation, and remodeling phases. Studies have shown that each requires various micronutrients and macronutrients to expedite and improve wound healing. Thus, patients and professionals must ensure adequate intake of these nutrients and ultimately avoid malnutrition to prevent complications and impair wound healing, especially in patients with underlying health issues.